Long-term Side Effects Of Chemotherapy For Breast Cancer

How Vitamins Affect Chemotherapy Drugs

Many people want to take an active role in improving their overall health. They want to help their bodys natural defenses fight the cancer and speed up their recovery from chemo. Most people think of vitamins as a safe way to improve health, so its not surprising that many people with cancer take high doses of one or more vitamins. But some vitamins might make chemo less effective.

More research is needed, but until more is known about the effects of vitamins on chemo, keep these points in mind:

• If your doctor has not told you to take vitamins, its best not to take any.
• Always check with your doctor first before starting to take a vitamin of any kind, even a simple multivitamin.
• Ask your doctors if and when it might be OK to start taking vitamins after treatment.
• If youre concerned about nutrition, you can usually get plenty of vitamins by eating a well-balanced diet. See Nutrition for People With Cancer to learn more about nutrition during and after cancer treatment.

What Are The Pros And Cons Of Chemotherapy For Breast Cancer

Like other cancer treatments, chemotherapy has benefits and risks. It can shrink breast tumors to the point where theyre easier to remove with surgery. It kills cancer cells all over your body, which is helpful if your cancer has spread. But it can cause unpleasant side effects like hair loss, nausea, and mouth sores.

If You Have Side Effects

Let your doctor or nurse know if you have side effects or are worried about anything.

When treatment ends you usually have regular appointments for about 5 years afterwards. You can talk to your doctor or nurse at these appointments. But you don’t have to wait for your next appointment if you get a new side effect or are worried about anything. You can bring the appointment forward.

• National Institute for Health and Care Excellence June 2018

• Treatment of primary breast cancerScottish Intercollegiate Guidelines Network, September 2013

• Postoperative radiotherapy for Breast Cancer: UK consensus statement

  The Royal College of Radiologists, 2016

• Early Breast Cancer: ESMO Clinical Practice Guidelines 2019F Cardoso and others

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Greater Use Of Adjuvant Chemotherapy Increases And Improvements In Outcomes

Along with screening, adjuvant systemic therapy has been key to the observed improvements in disease-free and overall survival in breast cancer 9 Improvements in survival already take into account death associated with therapy related toxicities. However, complications from systemic therapies like adjuvant chemotherapy may still negatively affect health-related quality of life . Therefore, it is important to examine the frequency, prevalence, and short/long-term impact on therapy-related toxicities, identify patients who might be at greatest risk, and ultimately individualize decisions regarding expected therapy benefits against known and often fixed rates of potential harms.

Coping With The Late Effects Of Chemotherapy

Long-term effects and late effects of cancer treatment are common. Many people find that their “new normal” is not what they would like, and feel frustrated by the symptoms. Cancer survival is improving. It’s only very recently that the term “survivorship” was coined, and the long-range physical, emotional, and spiritual aspects of surviving cancer are becoming better understood.

Many of the larger cancer centers now provide cancer rehabilitation to help people maximize their new normal. The STAR program for cancer rehabilitation was designed specifically to address symptoms that prevent cancer survivors from enjoying the quality of life they otherwise can.

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Early Menopause And Fertility

If youre hoping to have a child after breast cancer treatment, there are things you can do. Talk with a fertility specialist before starting treatment to discuss your options. Some options are described below.

Storing eggs

The most common way to preserve fertility is to store eggs before chemotherapy begins.

In both procedures, some of your eggs are collected, frozen and stored. The eggs may be fertilized by sperm from a spouse, partner or donor. Or you may store unfertilized eggs, which dont require a sperm donor.

After treatment, the eggs can be thawed and implanted into the uterus.

Insurance coverage for fertility services varies from state to state. Check with your insurance company to find out whats covered.

Protecting the ovaries

There are no known treatments guaranteed to protect the ovaries from chemotherapy.

However, drugs that shut down the ovaries during chemotherapy may help women return to regular menstrual periods after treatment ends. This may help preserve fertility.

Association Of Chemotherapy With Long

Overall, chemotherapy was associated with increased prevalence of all reported symptoms. Specifically, concentration deficits , nail changes , hair loss , tingling of hands , numbness and tingling of feet were increased by 20% versus adjuvant therapy without the use of antineoplastic chemotherapeutics .

Long-term prevalence of side effects in patients who received adjuvant therapies with or without the use of chemotherapeutic drugs .

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Feeling Unwell Or Tired

Many women do not feel as healthy after chemo as they did before. There is often a residual feeling of body pain or achiness and a mild loss of physical functioning. These changes may be very subtle and happen slowly over time.

Fatigue is another common problem for women who have received chemo. This may last a few months up to several years. It can often be helped, so its important to let your doctor or nurse know about it. Exercise, naps, and conserving energy may be recommended. If you have sleep problems, they can be treated. Sometimes fatigue can be a sign of depression, which may be helped by counseling and/or medicines.

Long Term Side Effects Of Chemotherapy For Breast Cancer

1. Infertility

2. Osteoporosis

Bone density loss is one of the side effects of chemotherapy for breast cancer patients due to premature menopause like state. There is increased risk of fractures and bone density loss should be measured periodically and treated to avoid any serious damage.

3. Neuropathy

The nerve damage results in numbness or tingling sensation. Most of the times the nerves recover and the symptoms disappear after finishing chemotherapy but sometimes these can stay for a very long time.

4. Damage to the Heart

Some chemotherapy medicines can damage the heart muscles and this damage can be permanent. The most common drugs causing this side effect are epirubicin and trastuzumab , especially in high doses.

5. Effects on Cognitive Function

The exact mechanism of some short term memory loss and concentration problems known as chemo brain or chemo fog is not very well understood. This long term and less common side effect of chemotherapy gets better after a few years.

6. Higher Risk of Infections

The most troublesome side effect of chemotherapy is increased susceptibility to infections. When the white blood cells are damaged the body is unable to fight off infections and is more likely to catch any kind of bug. The best thing is to avoid crowded places and limit contact with anyone with an infection. The white blood cells are at the lowest seven to ten days after the chemotherapy. Be careful at that time and contact your doctor immediately if you feel unwell.

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Take Hormone Therapies As Prescribed:

If you have been prescribed endocrine therapy its very important to take it exactly as prescribed. Research has shown that many women dont take their medication every day, either because they forget or because of the side effects. Endocrine therapy reduces the chance of breast cancer recurrence and when not taken as prescribed, the drugs are less effective.

Is Early Menopause A Risk Of Chemotherapy For Breast Cancer

Yes. If you have not gone through menopause, chemotherapy may stop your ovaries from producing estrogen. You may go into early menopause. If you want to have children in the future, discuss the risks of infertility with your healthcare provider.

Some womens ovaries begin working again after chemotherapy treatment. Women who want to bear children in the future may also choose fertility preservation before starting chemotherapy.

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Kidney And Bladder Effects

Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and bladder. This can result in a decreased ability of your kidneys to filter your blood.

Damage to the bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may include pain or urgency with urination, or blood in your urine.

How Does Chemotherapy Work

Chemotherapy works by attacking fast-growing cells in your body, including cancer cells. There are many different types of chemotherapy your medical oncologist will talk to you about whats most suitable for you. Sometimes more than one type of treatment may be effective for you, and you may be asked to decide which one to have. Your medical oncologist can tell you about the pros and cons of each.

Some questions you might like to ask include:

• What are the possible side effects of each treatment?
• How long is the course of each treatment?
• How will the treatment fit in with my lifestyle and personal circumstances?

Some chemotherapy drugs are given in tablet form, however, most are administered intravenously . As a result, it is useful to drink plenty of fluids, relax and keep your hands and arms warm, as this can help the nurse or doctor find your veins.

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Questions To Ask The Health Care Team

Learn as much as you can about the potential long-term effects of your cancer treatment from your health care team. You may want to schedule a special appointment to review your treatment summary. This document should include information about your cancer, treatment, and follow-up care. The American Society of Clinical Oncology offers cancer treatment summary forms to store this information.

Consider asking your health care team these questions:

• Can you write down which treatment I received?

• Am I at risk for specific late effects?

• Is there anything I can do to help prevent long-term side effects?

• What other specialists should I see to watch for potential late effects?

• What signs or symptoms of late effects should I watch for?

This information was originally published at .

Cognitive Function And Breast Cancer Treatment

The link between cognitive problems and chemotherapy remains unclear.

Problems with cognitive function may be related to the breast cancer treatment, regardless of the type of treatment . For example, women treated with hormone therapy have also reported cognitive problems .

Stress, anxiety, depression and insomnia can affect cognitive function . After a breast cancer diagnosis, women may have cognitive problems, even before treatment begins . These symptoms may first appear with the stress related to diagnosis and treatment and then become worse after chemotherapy or other treatment begins .

Medications used to treat the side effects of chemotherapy, such as sleeping aids and anti-nausea medications, can also cause these problems.

Age and genetic factors may also play a role. Some studies show older women with breast cancer tend to have more cognitive problems after chemotherapy than younger women . Genetic factors may also decrease cognitive function in older women with breast cancer .

The true extent of the cognitive effects of chemotherapy is not well understood. More research in this area is needed.

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For Metastatic Breast Cancer

Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.

What Is The Main Effect Of Chemotherapy

In cancer treatment, chemotherapy refers to the use of drugs whose main effect is either to kill or to slow the growth of rapidly multiplying cancer cells. Chemotherapy often includes using a combination of drugs, since this approach is more effective than using a single drug alone. There are many drug combinations used to treat breast cancer.

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Are There Ways To Prevent Hair Loss With Chemotherapy

Not everyone loses hair when receiving chemotherapy, but many people do. Some peoples hair only thins. Others lose the majority or all of their hair.

Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.

People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a cranial prosthesis or hair prosthesis. Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.

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What To Expect During Chemotherapy Treatment

Some chemotherapy medicines for breast cancer can be taken orally as pills. But most chemotherapy medicines are given as an infusion into a vein through an IV, a port, or a catheter over a period of time.

Chemotherapy is given in cycles a period of treatment followed by a period of recovery. One cycle may include chemotherapy on the first day and then three weeks of recovery with no treatment.

A chemotherapy treatment regimen is made up of several cycles. The number of cycles in a regimen and the total time it takes to complete one regimen depends on the chemotherapy medicines you receive. But most regimens take three to six months to complete.

In some cases, if the cancer is considered aggressive, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between cycles say every two weeks instead of every three weeks.

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Neurotoxicity And Cognitive Function

Neurotoxicity is commonly observed with adjuvant taxane regimens, with a frequency of grade 24 events that ranges from 13% to 22% in sequential anthracycline-taxane regimens.26 Available evidence indicates no association between toxicity and likelihood of clinical benefit, which then allows clinicians to reduce doses without fear of jeopardizing drug effectiveness.27 Unfortunately, limited options are available to prevent or treat taxane-induced painful neuropathy.28

Cognitive changes have long been observed following adjuvant chemotherapy for breast cancer,29 but studies in this area have been hampered by methodological limitations. In 2011, an international group of investigators issued recommendations on a core set of neuropsychological tests and common criterion for defining cognitive impairment/changes to improve the homogeneity of study methods and study design to allow comparisons across trials including meta-analyses. 30 These barriers were exemplified in a recent systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations, where factors like patient heterogeneity and use of non-standardized neuropsychological outcome measures allowed the authors to only suggest cognitive training and physical activity as promising current interventions.31 A conceptual framework based on models of studying ageing has also been proposed to guide future studies.32

Nerve Damage Around The Treatment Area

Scaring from radiotherapy may cause nerve damage in the arm on the treated side. This can develop many years after your treatment. Symptoms include tingling, numbness, pain, and weakness. In some people, it may cause some loss of movement in the arm and shoulder.

Speak to your doctor if you notice any of these symptoms.

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What Are Late Effects

Most women have side effects during treatment for breast cancer and for a few weeks after treatment ends. Usually, these side effects get better slowly and then stop. But sometimes side effects do not go away. Or they can develop months or years after treatment.

There are two commonly used terms for these side effects:

• Long-term effects Long-term effects begin during, or shortly after, treatment. They last for more than 6 months after treatment has finished. They may go away on their own, with symptoms getting better over 1 or 2 years after treatment. Or they may be permanent.
• Late effects Late effects are a delayed reaction to treatment. They do not appear during treatment, but can happen months or even years later.

In this information, we use the term late effects to describe both long-term and late effects.

Menstrual Changes And Fertility Issues

For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.

Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.

If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.

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Will My Menstrual Flow Be Different After Chemotherapy

Menstrual cycles vary from woman to woman. Some women may experience less frequent cycles than they had prior to chemotherapy. They may skip a period or increase the number of days between periods. Other women may have more frequent periods.

Some women may not experience a change in the length of their menstrual cycles but the flow pattern may be different than it was before treatment . Mixed patterns are also common: some women may have shorter menstrual cycles with heavier bleeding, or infrequent cycles with many days of a very high flow.

Even though periods tend to be irregular around the time of menopause, it is important to be aware of bleeding that is not normal for you. It is very important to call your physician if you ever have very heavy bleeding that is associated with weakness or dizziness.

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